101 Things the Fire Department wishes you knew



Thursday, April 16

...for the STEMI...


OK, that wasn't the exact dispatch, but we're getting there. Recently I've been sent to the "Broken hip/fall" and the "Abdominal Pain food poisoning" which are amazing deductions from a caller with no training, a call taker with minimal training and a computer system that doesn't have those options. Someone had to go out of their way and change the dispatch criteria. But I digress...

I'm not a big fan of EMS fads myself, but STEMI at least usually gets the Doctor's attention when you arrive at hospital. I haven't seen a difference in treatment yet, nor in time to lab, but boy do they start falling over each other when you say STEMI. The title got your attention, didn't it?

THE EMERGENCY

A man's family has called stating he has chest pains.

THE ACTION

Stop me if you've heard this one. Mid 50's man has an argument with the wife, then goes out to do some yard work. Comes back in a few minutes later pale, diaphoretic and holding his hand to his chest.
We've all had this one. His limb leads are clean. I,II,III have no changes so naturally we're looking at ASA, nitro, MS if needed, O2 and a lights and sirens return with an early radio call. I don't care if his fairy god mother appears and tells me it's not cardiac, this guy's having the big one.

What sticks out on this run for me was the home remedies that were attempted before we arrived. He speaks no English so the 12 year old is telling us of the elaborate treatments that were attempted. The circular bruises on his chest and abdomen are from a suctioncup type remedy called Fire Cupping that uses pressure to move deep tissues. It did not move his infarct. At least not in the direction they were hoping for. (photo from flickr search for fire cupping, not of patient)

They rubbed enough tiger balm ointment on his chest to send one of the firefighters searching for a window to open in the tiny living room. I caught a whiff of it as we were LEAVING the station there was so much. Wiping that stuff off is just bad, it gets on your gloves, then you touch the bags, you get the picture.

It was downstairs in the ambulance as we got the IV going and more nitro, we ran the 12 lead which showed the infarct right where we thought it was, anterior moving septal. And still no changes in leads I,II,III or our treatment.

As we arrived at the ER, 12 lead traces in hand, the staff was scrambling like never before. Active chest pain calls are always priority, but now that we call them STEMIs everyone runs around like that scene from the movie Airplane.

I hand the 12 leads to the Doctor who takes a cursory look and sets them down. She turns to a nurse and says, "Get a 12-lead on him as soon as possible please."

I picked it back up and handed it to her saying, "For comparrison. That's why we're doing this whole 12 lead in the field thing, right? To help you?"

"That's a bad trace and your electrodes could be better placed." Funny, the computer in the machine seemed to like it. I decided to refresh my skills by watching the technician remove my...hey wait...he's using my electrodes. The Doc takes the print out, which looks eerily familiar and tells the desk nurse to call the lab and tell them they're on their way.

Whole time was maybe 3-4 minutes and no one likes this Doc anyway, but what is the point of printing out those anterior leads if they are to be ignored?

Some Docs don't even ask for it, just take our word. Once we were even met in the parking lot by the lab team and went straight into the lab to transfer. That was weird.

But what made this event less stressful and more hilarious was when the Doctor finally got around to looking at her patient, just before they moved him.
The suctioncup remedy which left the ring bruises on his chest now showed giant bruises all over his torso wherever they moved the cups. She stopped in her tracks, reached out for my arm and asked if we had beat him.

"Not this one, I don't think." I said, looking at the ceiling.
"No we beat the old lady and the kid, not him." My partner said, walking back to the rig.

5 comments:

medicblog999 said...

Unbelievable!

I guess the next thing you are going to tell us is that they actually read your run forms as well???

It also always gets me annoyed when they repeat the blood glucose stick that you just did 5 minutes ago!

Michael Morse said...

But bitch and moan if you didn't do one...

Little Girl said...

Sounds like an ever so fun call.

When did you get rid of the smell of tiger balm?

You have to remember just because a paramedic is near the top of the Medic Evolutionary* scale that doesn't mean anything to a Doctor, because on the the Medical Doctor Evolutionary scale paramedic is probably near the bottom somewhere ....

* Medic Evolutionary Scale
- Flight Medic
- Paramedic
- God
- EMT
- EMR
- First Aider
- Joe Citizen
- Homeless Person/Hobo
- Cockroach
- Dispatch

With Love from your Friendly Neighborhood Dispatcher - Little Girl

The Happy Medic said...

Little Girl,
I have the highest respect for my dispatchers and radio folk. It's the people my system has chosen to hire to answer the phone and code the call that cause the problems.
When I try to get more info my dispatchers work hard to get the info from the call taker or do a callback on their own.

So add Call Taker into the scale under hobo and move yourself up above Flight Paramedic because all they do is take credit for my work at the hospital.

Kal said...

We frequently diagnose and heparinise/thrombolyse STEMIs in the field over here in Scotland. Any confirmed STEMI goes straight to the cath lab, skipping the ED.

It's cool, but a bit scary when you do it for the first time :)